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Challenge to The Massage Profession:

I am writing this letter after 17 years of being in full time practice in Seattle WA. WA State has been the leader in creating licensing and legislation and is now in the forefront of the insurance billing issues that massage therapists are faced with. The profession is at a major tuning point of being accepted by the medical profession and the insurance industry.  The future depends on how we as a profession define "massage" and so-called "medical massage".

The "Every Category Law" allows us to become contracted providers with insurance networks. We are one of two states that mandates that alternative therapies such as massage, acupuncture and naturopathy be We are able to bill health insurance companies along with the usual  automobile insurance companies and Labor & Industries for our services.  

This acceptance by the insurance industry and the medical profession brings with it a double edged sword. On one hand, we want our work to be accepted and understood. We want to be able to provide our clients with this service and build a profitable and successful practice. On the other hand comes the issues of having the insurance networks determine our standards of practice which is currently happening in WA State!!!!

Here are the facts that are currently happening in WA State:

  1. American  Whole Health Network is creating ( www.wholehealthpro.com) a Certified Medical Practitioners "certification" that will require massage therapists to have additional education to be able to be a contracted provider.  They are defining "medical massage" themselves.  Massage therapists have little say in this at this time. This is one way the networks are limiting the number of therapists in the network and the money they will have to pay out to massage therapists. This means that the health insurance networks are setting our standards of practice.
  2. Our licensing and certification requirements were initiated out of a need to protect the public from harm. Insurance networks continue to try to protect their consumers from harm by creating a bigger barrier to entering into their networks. What proof of harm is there? (see Keith Grant’s Review of Massage Governance )
  3. Automobile Insurance companies are becoming members of these networks which means that we are being paid a reduced fee for our services by automobile insurance companies while we were at one time able to get the amount that we charged.  The UCR for Seattle is $132 the last time I checked.  I personally think that is too high and it is high time that the insurance companies woke up, but when they pay us less what we charge our cash clients which in the Seattle area is $60-$85 per hour depending on the area (by my guess).
  4. We are being asked to prove medical necessity. Claims are being denied based on whether or not it is medically necessary yet we don't have any definition or any idea of what criteria the insurance companies use to determine medical necessity.  From what I understand, medical necessity is determined by the physicians, yet our chart notes are needed to show what we do.
  5. Our allowable fees are constantly being greatly reduced to less than our fees for services (by $20.00 - $70). 
  6. We are restricted in our use of CPT codes by some insurance companies, while others will pay for more. (We can only use 97124 with one company, while another will pay for 97140 and 97112.)  What code is allowed depends on how your individual state defines massage.  If massage is defined only as 'effleurage etc.  that is all you will be able to do.  Myofascial release and manual therapy are not allowed if your definition does not include it.  (This is from what I understand about this so far.  If anyone has a better idea of what is going on, please let me know.)
  7. Insurance plans are being written that depend on our ability to prove medical necessity.   Treatments are discontinued and in some cases, patients are not allowed to ever be treated for "back pain" again during the life of their policy.
  8. We are having to work more hours because we are being paid less.  There is more paperwork and phone calling involved in order to get paid. Billing insurance companies for our services is no longer profitable.
  9. Licensed Acupuncturists are already having their scope of practice defined by the insurance companies restricting their ability to treat other conditions except for pain. (One company will only allow acupuncturists to treat pain conditions, while their scope of practice allows for much more.)  What this means for us is that we need to protect our scope of practice.
  10. The insurance industry consistently reduces coverage for massage therapy benefits. (Allowable benefits have been drastically cut for their participating members. Policies that once allowed for $2,500 worth of rehabilitation therapy has been reduced to $1000 or less. This I know from my personal experience as a consumer of health insurance. We all know that if someone really has a serious back injury that $1000 worth of massage or Physical therapy will not take care of the problem.)

After attending a panel discussion group put on by the AMTA-WA here in Seattle on the meaning of credentialing by the insurance networks, I learned that the insurance companies are doing this basically ‘because they can".

Our profession has yet to declare what we stand for or what we want. We have not been able to step up and define "medical massage" nor determine what we want our role to be when working with the medical profession.

I believe that we need to even take it a step farther and determine if we want to be a part of the so-called medical profession and participate in such networks.

Do we want to work with a system of health care that is attempting to define our profession?

Do we want to participate in networks that have already forced medical doctors out of practice?

Do we really want to be paid less and less for what we do?

How can we create our own health care system model that incorporates our beliefs about healing?

How can we prove that the therapeutic relationship is what heals and not any technique that we do? How can we prove that it is the power of touch that heals and our ability to educate (draw forth) the client in the process of healing?

How can we define our profession and create a definition of "medical massage" that includes all therapy?  (Who are we to say what is or isn't therapy?)

My challenge to the profession is to step up and create a definition of massage that incorporates ALL healing touch modalities including relaxation massage. We have the opportunity to co-create our profession rather than just accepting what is handed to us. The dilemma is driven by politics and economics. 

The insurance networks bottom line it to make money while serving its members.

 What is our bottom line? How much will we take before we realize that the insurance networks are creating and defining our profession?

I am not sure what the answer is...how to make the insurance companies listen or what do we need to do to clarify our intent and mission as a whole...

Julie Onofrio, LMP
1402 Third Ave Suite 1428
Seattle WA 98101


The Every Category Law:



RCW 48.43.005- The Every Category Law http://www.leg.wa.gov/RCW/index.cfm?section=48.43.005&fuseaction=section

Vivian Madison- Mahoney: http://www.massagetoday.com/archives/2004/07/09.html


Ralph Stephens

My View From Here:
Medical Massage and More, Part I http://www.massagetoday.com/archives/2004/11/11.html

Medical Massage and More, Part II--
Relaxation vs. Medical Massage  http://www.massagetoday.com/archives/2005/01/10.html




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